The heart is a complex structure that acts as a pump to allow blood with its life-giving nutrients to be delivered around the body. The heart is the size of your fist and sits in the middle of the chest pointing towards the left side. It is a muscular structure that beats 100,000 times a day and pumps 5 litres of blood around the body using the blood vessels of the circulatory system. This allows delivery of oxygen and nutrients to all parts of the body and removal of carbon dioxide and waste products.
The heart is contained within a sac called the pericardium and is protected by the sternum and rib cage. The heart is divided into 4 chambers, 2 on the left and two on the right. The right and left sides of the heart are separated by a septum. The smaller upper chambers are called the atria and the larger lower chambers are called the ventricles. There are four valves in the heart which ensure that blood travels in one direction. The mitral valve and aortic valve are on the left side of the heart and the tricuspid valve and pulmonary valve are on the right side of the heart. The contraction of the heart is controlled by your heart’s natural pacemaker called the sinus node which sends electrical signals around the heart to give you each individual heartbeat.
With every heartbeat the heart muscle contracts and pushes blood through both the right and left sides of the heart simultaneously. Blood is pumped from the right side of the heart to the lungs where it picks up oxygen. The blood is returned to the left side of the heart where it is pumped around the body to deliver this oxygenated blood to your vital organs. The deoxygenated blood is returned to the right side of the heart ready to be pumped to the lungs again and continue this cycle. The heart muscle itself has his own constant blood supply in the form of coronary arteries which branch off the aorta as it leaves the heart.
Given the complex nature of the heart structure and function there are a number of conditions that can arise from heart disease. Please click here for more information on these conditions, how they are investigated and how they are managed.
Treatment options include lifestyle changes including diet and exercise advice, smoking cessation and weight loss if needed. There are a number of medications that minimise risk, slow the progression of coronary artery disease and alleviate symptoms. Some patients with coronary artery disease may benefit from percutaneous coronary intervention (PCI). This is an invasive procedure performed after coronary angiography using wires, balloons and stents (drug coated metal scaffolds) to treat the atheroma and improve blood flow to the heart muscle (see ‘Treatment’ section for more information). Dr Chandra will create a tailored management plan for you depending on your individual needs.
Arrhythmia can be diagnosed with a 12-lead ECG at the time of symptoms though prolonged heart rhythm monitoring is often required (24-hr Holter, 7-day Event recorder). Evaluation of the heart from a structural perspective with either an echocardiogram or cardiac MRI scan is also important. Further tests depends on the cause and range from blood tests to invasive electrophysiological studies of the heart.
The commonest cause of valve disease is age-related degeneration. Some people are born with valve abnormalities which manifest with symptoms in later life (congenital heart disease). Rheumatic fever in childhood can also cause valve damage which manifests with symptoms in later life (rheumatic heart disease). Heart valve disease can occur after a heart attack, with infection (endocarditis) or associated with heart failure or heart muscle disease.
If heart valve disease is severe further tests will be required and you may ultimately need valve intervention in the form of ‘keyhole’ procedures or open-heart surgery. If you are diagnosed with heart valve disease that is not severe you may require treatment with medications and require surveillance with echocardiography on an annual basis. Dr Chandra has a specialist interest in heart valve disease and performs transcatheter aortic valve implantation (TAVI) for severe aortic stenosis. He works closely with a network of Cardiothoracic surgeons as colleagues if heart surgery is needed.
The commonest cause of heart failure is coronary artery disease and/or heart attack causing long standing damage to the heart. It can also be caused by heart valve disease, heart rhythm abnormalities, congenital heart disease, heart muscle disease (cardiomyopathy) and high blood pressure. Heart failure can also be caused by infection/inflammation of the heart muscle, heart valves or the heart lining, as well as low blood counts (anaemia), excess alcohol intake, obesity and hormone imbalances.
The main symptoms of heart failure are shortness of breath (at rest or on exertion), fatigue and swelling of the feet and ankles. Heart failure can be suspected after clinical history, physical examination and risk factor evaluation. Diagnosis also relies upon blood tests, 12-lead ECG, chest X-ray and echocardiography. Appropriate treatment of heart failure depends on the underlying cause and there are a number of medications that can help alleviate symptoms and improve prognosis. Depending on the cause of your heart failure, there are invasive strategies that may also help including percutaneous coronary intervention (PCI), cardiac device therapy, intervention for structural heart disease or electrophysiological studies & ablation.
There is much that you can do for yourself to improve heart failure involving lifestyle changes. This includes monitoring for signs of weight gain suggesting excess fluid build-up, monitoring salt & fluid intake, and participating in regular exercise. A healthy balanced diet is important and will help manage heart failure and your overall health in general. Even with a diagnosis of heart failure, Dr Chandra will aim for you to have an active lifestyle with a fulfilling quality of life.
The commonest forms of inherited cardiac conditions are heart muscle disease (cardiomyopathy) and ion channelopathy. Examples of cardiomyopathy include dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Examples of ion channelopathy include Brugada syndrome (BrS), long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT).
Athletes remain a unique subset of individuals who are at the peak of physical fitness. If you are an elite athlete, professional athlete or an athlete in training you may require pre-participation screening. There are also certain (rare) heart conditions that can affect athletes and have important implications. If you are an athlete and have any concerns about your heart health please do not hesitate to get in touch for a specialist consultation.
Dr Navin Chandra and Team, this is to say a big “THANK YOU” for all the care, attention, proficiency and expert medical care during my operations.
A huge, massive thanks for looking after our dear Dad last week, you are all amazing and work so hard, thank you.
Thank you for literally giving my husband a second chance at life, you are amazing.
Doctor Chandra’s skills and the teamwork that he facilitated, was like watching the perfect tango on Strictly Come Dancing!
The synergy, skill and communication were seamless and problems met during the procedure were quickly managed. I know, as I was there and I was wide awake. It was inspiring! Later that evening Doctor Chandra’s patience and knowledge gave us the answers to our many questions and concerns.